2019 Volume 52 Issue 1 Pages 11-18
Neoadjuvant chemotherapy for advanced gastric cancer can be effective, but it is under development in Japan because of no strong evidence. As treatment strategy for advanced gastric cancer, we have performed neoadjuvant chemotherapy with S-1 plus oxaliplatin (SOX) after enrollment in a clinical trial. We encountered a case of perforation during neoadjuvant chemotherapy. A 76-year-old man was given a diagnosis of advanced gastric cancer (Type3) of the upper and posterior part of the stomach. The clinical stage was determined to be cT4aN1M0 cStage IIIA and we planned 2 courses of SOX as neoadjuvant chemotherapy. After 1 course of chemotherapy, the patient complained of severe abdominal pain. An urgent laparotomy was performed with a tentative diagnosis of generalized peritonitis. Surgical findings revealed a perforation in the tumor and we decided to perform curative total gastrectomy. Pathological findings demonstrated that there were only few cancer cells with increased fibrosis and inflammatory cells in the lesion of perforation. A report about perforation of gastric cancer during chemotherapy is rare. In this case, we suggest that the perforation was caused by chemotherapy-induced necrosis of gastric cancer cells. Our findings suggest that the risk of gastric perforation should be considered when administering chemotherapy to patients with advanced gastric cancer with a deep ulcer.
